The Effect of Psychiatric Advance Directives on Clinical Outcomes
Location
Center for Advanced Learning and Simulation (CALS)
Publication Date
April 2025
Start Date
17-4-2025 8:00 AM
Description
Background: Psychiatric advance directives (PADs) are legal documents that allow individuals with diminished cognitive capacity to indicate preferences for mental health treatment. Currently, 28 states legally recognize these documents. However, even in states with legally recognized PADs, their usage remains low. Some of the documented patient-centered benefits of PADs include strengthening the therapeutic relationship, an increased sense of patient autonomy, and increased involvement of personal patient support systems. Additionally, there have been multiple proposed benefits regarding clinical treatment outcomes including reduced rates of compulsory hospitalization, preventing administration of unwanted medications, and avoidance of undesired coercive crisis interventions such as restraints and forced seclusion. Despite the potential clinical utility of PADs, there seems to be a lack of consolidated information regarding their effects on treatment outcomes in the current literature. Methods: 49 peer-reviewed publications within the last 20 years were reviewed with special attention given to meta-analysis, systemic reviews, and clinical trials involving PAD-associated clinical outcomes. Keywords: psychiatric advance directives, clinical outcomes, crisis interventions, compulsory hospitalization, medication adherence, coercive/coercion. Inclusion Criteria: Discussion of clinical outcomes related to PADs specifically. Exclusion Criteria: Published before the year 2010, discussions of legal/ethical implications with no relevant clinical outcomes, studies which grouped PADs broadly with other forms of crisis intervention without separating PAD-specific data. Results: Analysis of the available literature has shown a reduction in the rate of compulsory admission of between 23% and 32%, an overall reduced risk of coercive crisis interventions (including forced medications, physical restraint, forced seclusion) of between 43-49%, and a decrease in the number of hospitalizations, compulsory admissions, and psychiatric hospital days for patients who completed PADs. Conclusions: While the available research is limited, the utilization of PADs may result in improved clinical treatment outcomes. However, more research needs to be done to better elucidate the effects of PADs on clinical outcomes.
Recommended Citation
Philastre, Doris MS and Bierma, Shane PhD, "The Effect of Psychiatric Advance Directives on Clinical Outcomes" (2025). Dept. of Psychiatry Research Symposium. 31.
https://digitalscholar.lsuhsc.edu/psych_rd/2025/presentations/31
The Effect of Psychiatric Advance Directives on Clinical Outcomes
Center for Advanced Learning and Simulation (CALS)
Background: Psychiatric advance directives (PADs) are legal documents that allow individuals with diminished cognitive capacity to indicate preferences for mental health treatment. Currently, 28 states legally recognize these documents. However, even in states with legally recognized PADs, their usage remains low. Some of the documented patient-centered benefits of PADs include strengthening the therapeutic relationship, an increased sense of patient autonomy, and increased involvement of personal patient support systems. Additionally, there have been multiple proposed benefits regarding clinical treatment outcomes including reduced rates of compulsory hospitalization, preventing administration of unwanted medications, and avoidance of undesired coercive crisis interventions such as restraints and forced seclusion. Despite the potential clinical utility of PADs, there seems to be a lack of consolidated information regarding their effects on treatment outcomes in the current literature. Methods: 49 peer-reviewed publications within the last 20 years were reviewed with special attention given to meta-analysis, systemic reviews, and clinical trials involving PAD-associated clinical outcomes. Keywords: psychiatric advance directives, clinical outcomes, crisis interventions, compulsory hospitalization, medication adherence, coercive/coercion. Inclusion Criteria: Discussion of clinical outcomes related to PADs specifically. Exclusion Criteria: Published before the year 2010, discussions of legal/ethical implications with no relevant clinical outcomes, studies which grouped PADs broadly with other forms of crisis intervention without separating PAD-specific data. Results: Analysis of the available literature has shown a reduction in the rate of compulsory admission of between 23% and 32%, an overall reduced risk of coercive crisis interventions (including forced medications, physical restraint, forced seclusion) of between 43-49%, and a decrease in the number of hospitalizations, compulsory admissions, and psychiatric hospital days for patients who completed PADs. Conclusions: While the available research is limited, the utilization of PADs may result in improved clinical treatment outcomes. However, more research needs to be done to better elucidate the effects of PADs on clinical outcomes.